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Related Experiment Videos

Interventions for treating calcaneal fractures.

S A Bridgman1, K M Dunn, D J McBride

  • 1Keele University School of Postgraduate Medicine, Thornburrow Drive, Hartshill, Stoke-on-Trent, Staffordshire, UK, ST4 7QB. stephen.bridgman@nsha.wmids.nhs.uk

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary

Treatments for calcaneal (heel bone) fractures are limited by few, small, and low-quality randomized trials. While surgery may reduce work absence and shoe problems, its risks versus benefits remain unclear, necessitating further research.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Evidence-Based Medicine

Background:

  • Calcaneal fractures account for 1-2% of all bone fractures.
  • Optimal treatment strategies require robust clinical evidence.

Purpose of the Study:

  • To systematically identify and evaluate randomized trials for calcaneal fracture treatments.
  • To synthesize current evidence on operative versus non-operative management and novel therapies.

Main Methods:

  • Comprehensive literature search of multiple databases (MEDLINE, EMBASE, CINAHL, Cochrane Registers) up to October 1998.
  • Inclusion of randomized and quasi-randomized trials comparing interventions for calcaneal fractures.
  • Independent quality assessment and data extraction by two reviewers, with meta-analysis where appropriate.

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Main Results:

  • Four trials were included, all with methodological flaws. Three trials (134 patients) comparing open reduction internal fixation (ORIF) with non-operative care showed no significant difference in pain but favored ORIF for return to work and shoe wear.
  • One trial (23 patients) suggested impulse compression therapy improved pain and subtalar movement, with earlier return to work.
  • Pooled analysis indicated ORIF may reduce work absence and improve shoe wear compared to non-operative treatment.

Conclusions:

  • Current randomized evidence for calcaneal fracture management is limited by trial size and quality.
  • The benefits of ORIF over non-operative treatment require further investigation due to unclear risk-benefit balance.
  • Impulse compression therapy shows potential but needs validation; large, high-quality RCTs are essential for definitive conclusions and exploring other interventions.